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CaP paste performed better than bone graft for tibial plateau fractures

Articular subsidence rates were 27% for bone graft, 7% for bone substitute paste through 12 months’ postop.

Issue: April 2004

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SAN FRANCISCO — Results of a multicenter, randomized, prospective trial suggested that use of a calcium phosphate bone substitute paste to repair subarticular tibial plateau fractures may eventually replace iliac crest bone graft as the gold standard of treatment for these defects.

According to investigators, the calcium phosphate paste, called Alpha-Bone Substitute Material (Alpha-BSM), was injected or placed into a defect and then hand-packed. It was associated with fewer adverse effects than autogenous iliac crest bone graft (AIBG), including a notably reduced incidence of graft subsidence at three to 12 months.

Studies comparing function in patients treated with the two materials yielded results that were similar, but those treated with Alpha-BSM paste had slightly better range of motion in flexion and extension at the six- and 12-month follow-ups, according to Thomas A. Russell, MD, at the Campbell Clinic in Memphis, Tenn. He presented the findings during the American Academy of Orthopaedic Surgeons 71st Annual Meeting, held here.

Better choice

“Bioresorbable calcium phosphate materials with properties of Alpha-BSM appear to be a better choice for subarticular defects than AIBG in tibial plateau fractures,” Russell said. “We believe that randomized studies using AIBG as a control in fractures requiring subarticular management should be avoided in the future for our patients and that AIBG is not the gold standard in the tibial plateau model.”

One hundred and nineteen patients (73 men, 46 women) with 120 acute closed tibial plateau fractures were enrolled in the study conducted from 1999 to 2002 at one Canadian and eight U.S. centers. Patient ages ranged from 16 to 77. Randomization was done at the time of surgery, with one patient treated with AIBG for every two treated with Alpha-BSM paste. Surgery was performed within 30 days of injury in all cases using a standard plate and screw, open reduction internal fixation technique.

“Union was achieved in all fractures in the same time period. There was no difference in smokers,” Russell said. One patient in each group developed an infection that later resolved.

“There was no dissolution of bone graft and fairly good results as far as no major loss of fixation,” he said. Results were based on radiographic and functional outcomes.

Dr. Russell is a consultant to Etex Corp.

For more information:

• Russell TA, Leighton RK, Bucholz RW, et al. The gold standard in tibial plateau fractures? A prospective multicenter study of AIBG vs. Alpha-BSM. #64. Presented at the American Academy of Orthopaedic Surgeons 71st Annual Meeting. March 10-14, 2004. San Francisco.